Postoperative Bile Duct Strictures: Management and Outcome in the 1990s

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

“…It has been described that once an injury occurs, a patient's possible mortality increases to near 18 % [2,3]. In addition to this significant mortality, the monetary cost of BDI repair can be 26 times that of an uncomplicated procedure, which is directly related to the increased morbidity, mortality, length of hospitalization, and number of outpatient care days [46,74].…”

“…Ludwig et al found that the most common lesions are type C and D according to the Neuhaus classification, injuries that often can require a biliodigestive anastomosis, which confers significant morbidity and mortality [9]. Lillemoe et al [46] also compared BDIs sustained during LC versus OC and found that the injuries associated with LC tended to be more complex, with more than 60 % classified as Bismuth 3 or higher compared with only 40 % of this severity as a result of OC.…”

Evaluation of Biliary Enteric Anastomosis in Benign Biliary Disorders

“…Primary sclerosing cholangitis, a biliary tract disease of unknown cause, is also an important cause of bile duct strictures. However, a vast majority of benign bile duct strictures occur after surgery on the gallbladder or biliary tree [3]. The widespread use of laparoscopic cholecystectomy (LC) has dramatically increased the incidence of bile duct injuries and strictures associated with cholecystectomy [4][5][6][7][8].…”

“…Although endoscopic techniques have provided us an alternative mode of treatment, endoscopic stenting, even if performed by an experienced team, could be hindered by the major disadvantage of multiple procedures that must be repeated to accomplish success [9]. The optimal management of patients with major bile duct injuries and strictures in the current era remains surgical reconstruction [3]. Complication rates vary from 7 to 10 % with mortality of 0.5-2 % [13].…”

“…Main aim in management of benign obstructive jaundice is to prevent biliary stasis and to prevent back-pressure effects. This is best achieved by obtaining internal drainage through biliary enteric anastomosis [3]. In our present study, we present our experience with 121 cases of benign obstructive jaundice managed using various modalities of biliary enteric anastomosis.…”